Management of type 1 type 2 diabetes mellitus in conditions of armed conflict
Keywords:type 1 diabetes mellitus, type 2 diabetes mellitus, management, armed conflict, humanitarian crises
Humanitarian crises caused by armed conflict are constantly growing and present a serious global problem for health systems. The war in Ukraine produced about 4.8 million Ukrainians seeking temporary protection abroad, and about 10 million received the status of an internally displaced person. The situation in Ukraine has been described as potentially the largest migration crisis in Europe in the last century. As humanitarian crises become widespread and prolonged, chronic diseases such as diabetes mellitus (DM) are becoming increasingly important. Food security, limited access to medical facilities and medicines, and economic difficulties are just some of the many difficulties faced by patients with DM in armed conflict. The experience of the functioning of the health care system in conditions of armed conflict, on the example of other countries, shows that in the short term, the priority should be to ensure the continuity of insulin therapy and access to basic oral sugar-lowering agents and educational programs for patients on self-control of the disease with an emphasis on recognizing the symptoms of hypoglycemia, diabetic ketoacidosis, and dehydration; in the long term — ensuring access to high-quality medical care and medicines, training of local and international providers of medical services for the diagnosis and treatment of DM and its acute complications and the development of clinical guidance on the management of patients in these conditions. Humanitarian crises in the world have become more protracted, and therefore health workers must go beyond direct basic primary care and address the long-term health consequences of those affected. Further research is needed to be aimed at improving the quality of medical care for patients with DM in the context of the humanitarian crisis caused by the armed conflict, there is a need to develop simplified, cost-effective models of monitoring the condition of patients, the quality of medical care and the availability of medicines to patients in this category.
Gonçalves Júnior J, de Amorim LM, Neto MLR, Uchida RR, de Moura ATMS, Lima NNR. The impact of "the war that drags on" in Ukraine for the health of children and adolescents: Old problems in a new conflict? Child Abuse Negl. 2022 Jun;128:105602. doi:10.1016/j.chiabu.2022.105602.
Korinek K, Teerawichitchainan B, Zimmer Z, et al. Design and measurement in a study of war exposure, health, and aging: protocol for the Vietnam health and aging study. BMC Public Health. 2019 Oct 23;19(1):1351. doi:10.1186/s12889-019-7680-6.
Fonseca VA, Smith H, Kuhadiya N, et al. Impact of a natural disaster on diabetes: exacerbation of disparities and long-term consequences. Diabetes Care. 2009 Sep;32(9):1632-1638. doi:10.2337/dc09-0670.
Mipatrini D, Balcılar M, Dembech M, Ergüder T, Ursu P. Survey on the health status, services utilization and determinants of health: Syrian refugee population in Turkey. Copenhagen, Denmark: WHO Regional Office for Europe; 2019. 99 p.
United Nations High Commission for Refugees (UNHCR); United Nations Children's Fund (UNICEF); World Food Programme (WFP). Vulnerability Assessment of Syrian Refugees in Lebanon: VASyR 2017. Geneva, Switzerland; 2017. 125 p.
Banjong O, Menefee A, Sranacharoenpong K, et al. Dietary assessment of refugees living in camps: a case study of Mae La Camp, Thailand. Food Nutr Bull. 2003 Dec;24(4):360-367. doi:10.1177/156482650302400406.
Owens-Gary MD, Zhang X, Jawanda S, Bullard KM, Allweiss P, Smith BD. The Importance of Addressing Depression and Diabetes Distress in Adults with Type 2 Diabetes. J Gen Intern Med. 2019 Feb;34(2):320-324. doi:10.1007/s11606-018-4705-2.
Alessi J, Scherer GDLG, Erthal IN, et al.. One in ten patients with diabetes have suicidal thoughts after 1 year of the COVID-19 pandemic: We need to talk about diabetes and mental health not only during Suicide Prevention Awareness Month. Acta Diabetol. 2022 Jan;59(1):143-145. doi:10.1007/s00592-021-01807-6.
United Nations High Commission for Refugees (UNHCR). Health access and utilization survey: access to health services in Jordan among Syrian and non-Syrian refugees - February 2018. Geneva, Switzerland; 2018. 11 p.
Kehlenbrink S, Mahboob O, Al-Zubi S, et al. An inter-humanitarian agency study of diabetes care and surveillance in humanitarian settings. Lancet Diabetes Endocrinol. 2022 Mar;10(3):159-162. doi:10.1016/S2213-8587(22)00036-5.
Crocker TF, Brown L, Lam N, Wray F, Knapp P, Forster A. Information provision for stroke survivors and their carers. Cochrane Database Syst Rev. 2021 Nov 23;11(11):CD001919. doi:10.1002/14651858.CD001919.pub4.
Elliott JA, Das D, Cavailler P, et al. A cross-sectional assessment of diabetes self-management, education and support needs of Syrian refugee patients living with diabetes in Bekaa Valley Lebanon. Confl Health. 2018 Sep 12;12:40. doi:10.1186/s13031-018-0174-9.
Khader A, Farajallah L, Shahin Y, et al. Cohort monitoring of persons with diabetes mellitus in a primary healthcare clinic for Palestine refugees in Jordan. Trop Med Int Health. 2012 Dec;17(12):1569-1576. doi:10.1111/j.1365-3156.2012.03097.x.
Maystruk G, Perone SA, Anufriyeva V, et al. Caring for people with diabetes and non-communicable diseases in Ukraine: a humanitarian emergency. Lancet Diabetes Endocrinol. 2022 May;10(5):308. doi:10.1016/S2213-8587(22)00105-X.
How to Cite
This work is licensed under a Creative Commons Attribution 4.0 International License.